=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003720863
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA PFANNENSTIEL MULL M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2026
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 LANIER AVE W STE 603
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-7644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-884-5085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 614 GRECKEN GRN
-----------------------------------------------------
City | PEACHTREE CTY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30269-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-362-8479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP010350
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------